Restless Pharma Marketing

Yesterday I posted a commentary on "disease mongering" (see "Disease Awareness or Disease Mongering?") in which I mentioned Restless Leg Syndrome as an example. Jane Chin, a member of the PHARMA-MKTING Online Discussion Group, made these comments:

Whenever I see the ad for "restless leg syndrome" on TV, I really get miffed. One may argue that it's such a rare condition that if it weren't televised, those who suffer from it may not catch on. Same principle as putting "America's Most Wanted" on TV.

On the other hand, come on! Restless leg syndrome on TV, marketed to consumers on primetime?

I have the same reaction for ED ads. An ad I particularly can't stand is one where a woman is on the porch outside her house, and she's talking about her husband's ED, and how after taking the branded drug, their relationships have become so much better, therefore "ask your doctor about ..." Now drug ads are trying to get other people in our lives to make us "ask our doctor about" a drug?

Drug companies are going to unbranded ED "education" because there are just too many brands now. Whatever clever brand ads you come up with won't matter unless you "expand the total market" and everyone gets a slice of a bigger pie, instead of fighting over a bigger slice of the same pie. (See her post in the Medical Science Liaison Blog).

Another member of the PHARMA-MKTING Online Discussion Group retorted:

According to the National Sleep Foundation, RLS may afflict up to 10% of the population. Not quite a "rare condition".

It seems to me that many of these syndromes affect similar numbers of people. 10% here, 10% there; pretty soon you have everyone suffering from one or two of these things. That's the point of critics who claim that the pharmaceutical industry is turning everyday, minor problems into medical conditions that must be treated. Restless Leg Syndrome may be one of these.

You have to take a critical look at any statistic promulgated by the Restless Leg Syndrome Foundation.

If you visit the RLS Foundation's Web site, it's a bit difficult to find out where it gets its money from. You have to dig down a few pages to learn that GSK and Boehringer Ingelheim are "Gold Level Sponsors." Both of these pharmaceutical companies market treatments for RLS.

Not that's anything wrong with that.

But an RLS Foundation November 15, 2005 Press Release announced the first RLS Foundation Science Award went to Ronald L. Krall, MD, Senior VP of Worldwide Development at GSK! That's a first! Pipe money into a foundation and viola! you (or a VP in your company) gets an award!

Not only that, Dr. Richard Allen, a member of the RLS Foundation's Medical Advisory Board, proudly reveals in the press release that he had the "pleasure" of "collaborating" with the research team selected by Dr. Krall to do studies supposedly supporting the data on the prevalence of RLS in the US and in Europe.

[Allen also hinted that RLS may have something to do with attention deficit disorder in children, another condition often criticised as over treated. Will we soon see kids on Requip, GSK's drug for RLS?]

A couple of other suspicious findings: Although the RLS Foundation Web site claims the organization was incorporated in 1992, the earliest press release available on the site is dated November 14, 2005, just one day before the press announcement of FDA approval of Requip in the US. Even the color scheme of the Requip.com and RLS Foundation Web sites match (blue and orange). Coincidence? Probably; there are so many sites with those colors!

So, to sum up.

• GSK is a Gold Corporate Sponsor of the RLS Foundation, which means it has given the foundation a good chunk of change (the amount is not revealed; I'm going to ask for their financials and see where it gets me);
• at least one member of the Foundation's Medical Advisory Board has financial ties to a pharmaceutical company (GSK) with a treatment for RLS;
• the PR activity of the organization seems to have picked up right when that company's drug hit (ReQuip) the market;
• (I'm letting the award to a GSK VP slide.)

I am sure that a little more investigation would reveal many more ties between GSK and/or Boehringer Ingelheim and the RSL Foundation. Investigation, however, is not the forte of the many journalists who have written stories about RLS and its prevalence (see, for example, "Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick" which presents results of an analysis of RLS news stories).

Some Additional Comments
I received some comments on this topic from colleagues via email that you might find interesting:

Sameer Nanda wrote:

Thanks John for choosing another interesting/debatable topic as always. I will
prefer to be neutral in this regard. On one hand, there is a real need for
education of certain life threatening diseases/vaccination program especially in
developing countries (AIDS, Breast Cancer, Polio, Tetanus, Rabies etc), on the
other hand, pharma companies generate sales based on earlier created
"patho-phobic" brain space. It is probably another classic example of imbalance
of "done and overdone".

Several years back, I remember the presentation on Hepatitis B by a very
reputed global pharma company. The speaker explained why one should get
vaccinated for Hep-B (in India it's not covered by government vaccination
program) with the help of many colorful and complicated charts, graphs, figures
and tables. Somehow at one point the speaker (a top ranked marketing
professional from the company) tried to instill the idea that one can transmit
Hep-B by sharing the same swimming pool with a Hep-B patient. When I asked for
data supporting his vies, he promised to revert back, which he never did.

ED in 80% of cases psychogenic. With proper psychological counseling and
therapy (e.g. behavioral therapy), ED can be successfully treated. However it
seems people taking medications more and more before trying to resolve the real
problem (potentially solvable problems of psychogenic nature).

Everything said and done, probably it is difficult to draw a thin line between
"educational campaign" and "unethical camouflaged sales campaign".

The Hep-B story reminds me of the "Thanks for Smoking" movie trailer (I haven't seen the movie itself) where the Tobacco Industry PR guy is testing before a Senate committe that "just the other day he saw a report that smoking can help cure Parkinson's Disease." I'm paraphrasing. Not that there's any relation between the pharma and tobacco industries (other than their low level of trust among consumers).

The following was submitted by Mario Cavallini:

I enjoy April Fools Day news pranks, and BMJ pulled a great one this year with "Scientists find new disease: motivational deficiency disorder", describing a fictitious syndrome and its treatment, a cannabinoid receptor antagonist called "indolebant."

But BMJ didn't stop there. As part of the joke report, the writer associated the story with an Inaugural Conference on Disease-Mongering and a themed-issue of PLoS Medicine devoted to the subject. It takes some persistent investigation, such as finding an earlier article by the prank author and conference organizer to be sure, but the conference and the PLoS articles are legitimate.

Perhaps these legitimate trappings, as well as some straight-out joke-mongering by the prank author, caused the Australian Broadcast Corporation and others to treat the prank as legitimate news. At any rate, BMJ followed up by castigating news services for being so foolish as to believe them.

I would say that BMJ went too far in confusing a practical joke with a teachable moment. The authors put a lot of effort into misleading the ABC and the general public, with the intention of spurring people to greater skepticism of drug marketing and general news reports. What they have merited, however, is greater skepticism toward the medical equivalent of the military-industrial complex -- the university-journal complex, which has just as much vested interest in monopolizing share of voice as the pharmaceutical industry does.